MAR IX

JONATHAN MALABANAN M.D.

Surgery Resident

Ospital Ng Maynila Medical Center

MEDICAL ANECDOTAL REPORT

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Surgeon Can Become An Anesthesiologist

(September 2007)

Narration

It was around 12:30 in the morning. A 52 year old patient diagnosed with wet gangrene of 2^nd digit of right foot was already wheeled in the operating room. His BP was normal during his stay in the ward. Inside the operating room, his BP shoots up to 180/100. I together with the anesthesiologist decided to give clonidine 75 mcg Q15 minutes for a maximum of 4 doses.

One hour passed, but still the patient’s BP was 180/100. We can’t give another dose of clonidine since we already gave the maximum dosage. The anesthesiologist at that time was asking me if I will postpone the operation. I told her that we still have another option aside from giving SAB, the ankle block. I asked the anesthesiologist to perform the ankle block for the patient. But they were not confident of the procedure. I informed my senior that we can’t give the SAB because of the uncontrolled hypertension and the second option was to proceed to ankle block. I asked the consent of the patient regarding the method of anesthesia.

My immediate senior then accompanied me in performing the ankle block. The procedure of ray amputation went well and painless. The patient was then wheeled back to ward and his BP went to normal again.

Insight: (Physical, Psychosocial, Ethical) (Discovery, Stimulus, Reinforcement)

Different types of patients have different approaches. Some patients need a little talk with conviction for them to follow your advices. Some needs actual examples of the outcomes of some patient for them to follow you. Some also needs a little art of persuation, for you to convince them. We listen to them and make them feel that we are here to help. But whatever the method is, we need to gain their trust in order to improve their quality of life.

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